Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols
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There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed.
Narrative review and presentation of PBM parameters are based on current evidence and expert opinion.
PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780–830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2–3 J (J/cm2), and no more than 6 J/cm2 on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations.
PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.
KeywordsLow-level laser therapy Low-level light therapy Photobiomodulation Mucositis Orofacial complications Chemotherapy Radiation therapy Head and neck cancer LLLT PBM
Compliance with ethical standards
This article is based on a narrative review of existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with the clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and as such does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.
Judith A.E.M. Zecha, Andrei Barasch, Sharon Elad, Steven Sonis, Cesar A. Migliorati, Marie-Thérèse Genot, Dan M.J. Milstein, Liset Lansaat, Irene Jacobi, Judi van Diessen, Jan. de Lange, Ludi E. Smeele and Mark M. Schubert have no disclosures relevant to this work to report.
Judith E. Raber-Durlacher, Raj G. Nair, Joel B. Epstein, Ron van der Brink, Josep Arnabat Dominguez, and Rene-Jean Bensadoun have received travel expenses and hotel accommodation for the founding meeting of iGLOB from THOR Photomedicine Ltd., UK. Raj Nair has received an honorarium from THOR, UK. Michael R Hamblin was supported by US NIH grant R01AI050875.
- 2.Elting LS, Keefe DM, Sonis ST, Garden AS, Spijkervet FK, Barasch A, et al. (2008) Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life. Cancer 113(10):2704–2713. doi: 10.1002/cncr.23898 PubMedCrossRefGoogle Scholar
- 3.Cooperstein E, Gilbert J, Epstein JB, Dietrich MS, Bond SM, Ridner SH, et al. (2012) Vanderbilt Head and Neck Symptom Survey version 2.0: report of the development and initial testing of a subscale for assessment of oral health. Head Neck. 34(6):797–804. doi: 10.1002/hed.21816 PubMedCrossRefGoogle Scholar
- 4.Hunter KU, Schipper M, Feng FY, Lyden T, Haxer M, Murdoch-Kinch CA, et al. (2013) Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiat Oncol Biol Phys 85(4):935–940. doi: 10.1016/j.ijrobp.2012.08.030 PubMedPubMedCentralCrossRefGoogle Scholar
- 5.Verdonck-de Leeuw IM, Buffart LM, Heymans MW, Rietveld DH, Doornaert P, de Bree R, et al. (2014) The course of health-related quality of life in head and neck cancer patients treated with chemoradiation: a prospective cohort study. Radiother Oncol: J Eur Soc Ther Radiol Oncol 110(3):422–428. doi: 10.1016/j.radonc.2014.01.002 CrossRefGoogle Scholar
- 6.Raber-Durlacher JE, Scully C (2012) Oral cancer: comprehending the condition, causes, controversies, control and consequences. 14. Mucositis. DentUpdate 39(2):145–147Google Scholar
- 9.Bjordal JM, Bensadoun RJ, Tuner J, Frigo L, Gjerde K, Lopes-Martins RA (2011) A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis. Support Care Cancer 19(8):1069–1077. doi: 10.1007/s00520-011-1202-0 PubMedCrossRefGoogle Scholar
- 17.Lacouture ME, Anadkat MJ, Bensadoun RJ, Bryce J, Chan A, Epstein JB, et al. (2011) Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer 19(8):1079–1095. doi: 10.1007/s00520-011-1197-6 PubMedPubMedCentralCrossRefGoogle Scholar
- 22.Bernier J, Bonner J, Vermorken JB, Bensadoun RJ, Dummer R, Giralt J, et al. (2008) Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck. Ann Oncol 19(1):142–149. doi: 10.1093/annonc/mdm400 PubMedCrossRefGoogle Scholar
- 27.Costa MM, Silva SB, Quinto AL, Pasquinelli PF, de Queiroz dos Santos V, de Cassia SG, et al. (2014) Phototherapy 660 nm for the prevention of radiodermatitis in breast cancer patients receiving radiation therapy: study protocol for a randomized controlled trial. Trials 15:330. doi: 10.1186/1745-6215-15-330 PubMedPubMedCentralCrossRefGoogle Scholar
- 31.Fife D, Rayhan DJ, Behnam S, Ortiz A, Elkeeb L, Aquino L, et al. (2010) A randomized, controlled, double-blind study of light emitting diode photomodulation for the prevention of radiation dermatitis in patients with breast cancer. Dermatol Surg: Off Publ Am Soc Dermatol Surg [et Al] 36(12):1921–1927. doi: 10.1111/j.1524-4725.2010.01801.x CrossRefGoogle Scholar
- 34.Russi EG, Corvo R, Merlotti A, Alterio D, Franco P, Pergolizzi S, et al. (2012) Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: review and recommendations of the supportive task group of the Italian Association Of Radiation Oncology. Cancer Treat Rev 38(8):1033–1049. doi: 10.1016/j.ctrv.2012.04.002 PubMedCrossRefGoogle Scholar
- 36.Mittal BB, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE, et al. (2003) Swallowing dysfunction–preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol Biol Phys 57(5):1219–1230PubMedCrossRefGoogle Scholar
- 40.van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ (2011) A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia 26(2):155–170. doi: 10.1007/s00455-010-9288-y PubMedPubMedCentralCrossRefGoogle Scholar
- 42.Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ (2008) Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol 26(22):3770–3776. doi: 10.1200/JCO.2007.14.6647 PubMedCrossRefGoogle Scholar
- 47.Roe JW, Carding PN, Dwivedi RC, Kazi RA, Rhys-Evans PH, Harrington KJ, et al. (2010) Swallowing outcomes following intensity modulated radiation therapy (IMRT) for head & neck cancer - a systematic review. Oral Oncol 46(10):727–733. doi: 10.1016/j.oraloncology.2010.07.012 PubMedCrossRefGoogle Scholar
- 48.van der Molen L, Heemsbergen WD, de J R, van Rossum MA, Smeele LE, Rasch CR, et al. (2013) Dysphagia and trismus after concomitant chemo-intensity-modulated radiation therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures. Radiother Oncol 106(3):364–369. doi: 10.1016/j.radonc.2013.03.005 PubMedCrossRefGoogle Scholar
- 49.Kraaijenga SA, Oskam IM, van der Molen L, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW (2015) Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol 51(8):787–794. doi: 10.1016/j.oraloncology.2015.05.003 PubMedCrossRefGoogle Scholar
- 50.Kraaijenga SA, van der Molen L, van den Brekel MW, Hilgers FJ (2014) Current assessment and treatment strategies of dysphagia in head and neck cancer patients: a systematic review of the 2012/13 literature. Current Opinion Support Palliative Care 8(2):152–163. doi: 10.1097/spc.0000000000000050 CrossRefGoogle Scholar
- 51.Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Vadhiraja BM (2012) Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients - a triple blinded randomized controlled trial. Radiother Oncol 104(3):349–354. doi: 10.1016/j.radonc.2012.06.011 PubMedCrossRefGoogle Scholar
- 53.Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, et al. (2010) A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 18(8):1039–1060. doi: 10.1007/s00520-010-0827-8 PubMedCrossRefGoogle Scholar
- 57.Vissink A, Mitchell JB, Baum BJ, Limesand KH, Jensen SB, Fox PC, et al. (2010) Clinical management of salivary gland hypofunction and xerostomia in head-and-neck cancer patients: successes and barriers. Int J Radiat Oncol Biol Phys 78(4):983–991. doi: 10.1016/j.ijrobp.2010.06.052 PubMedPubMedCentralCrossRefGoogle Scholar
- 60.Buglione M, Cavagnini R, Di Rosario F, Sottocornola L, Maddalo M, Vassalli L, et al. (2016) Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: dental pathologies and osteoradionecrosis (part 1) literature review and consensus statement. Critical Rev Oncology/Hematol 97:131–142. doi: 10.1016/j.critrevonc.2015.08.010 CrossRefGoogle Scholar
- 68.Cowen D, Tardieu C, Schubert M, Peterson D, Resbeut M, Faucher C, et al. (1997) Low energy helium-neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. Int J Radiat Oncol Biol Phys 38(4):697–703PubMedCrossRefGoogle Scholar
- 70.Oton-Leite AF, Elias LS, Morais MO, Pinezi JC, Leles CR, Silva MA, et al. (2013) Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to radiotherapy. Spec Care Dent: Off Publ Am Assoc Hosp Dent Acad Dent Handicap, Am Soc Geriatr Dent 33(6):294–300. doi: 10.1111/j.1754-4505.2012.00303.x CrossRefGoogle Scholar
- 72.Boltong A, Aranda S, Keast R, Wynne R, Francis PA, Chirgwin J, et al. (2014) A prospective cohort study of the effects of adjuvant breast cancer chemotherapy on taste function, food liking, appetite and associated nutritional outcomes. PLoS ONE 9(7):e103512. doi: 10.1371/journal.pone.0103512 PubMedPubMedCentralCrossRefGoogle Scholar
- 76.Yamashita H, Nakagawa K, Nakamura N, Abe K, Asakage T, Ohmoto M, et al. (2006) Relation between acute and late irradiation impairment of four basic tastes and irradiated tongue volume in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 66(5):1422–1429. doi: 10.1016/j.ijrobp.2006.08.037 PubMedCrossRefGoogle Scholar
- 77.Romeo U, Del VA, Capocci M, Maggiore C, Ripari M (2010) The low level laser therapy in the management of neurological burning mouth syndrome. A pilot study. Ann Stomatol (Roma) 1(1):14–18Google Scholar
- 85.van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Hilgers FJ (2009) Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 266(6):889–900. doi: 10.1007/s00405-008-0817-3 PubMedCrossRefGoogle Scholar
- 86.Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R (2012) “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys 83(1):210–219. doi: 10.1016/j.ijrobp.2011.06.1954 PubMedCrossRefGoogle Scholar
- 87.Carrillo JS, Calatayud J, Manso FJ, Barberia E, Martinez JM, Donado M (1990) A randomized double-blind clinical trial on the effectiveness of helium-neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars. Int Dental J 40(1):31–36Google Scholar
- 88.Aras MH, Gungormus M (2010) Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)–intraoral and extraoral–on trismus and facial swelling following surgical extraction of the lower third molar. Lasers Med Sci 25(5):641–645. doi: 10.1007/s10103-009-0684-1 PubMedCrossRefGoogle Scholar
- 94.Schuurhuis JM, Stokman MA, Witjes MJ, Dijkstra PU, Vissink A, Spijkervet FK (2015) Evidence supporting pre-radiation elimination of oral foci of infection in head and neck cancer patients to prevent oral sequelae. A systematic review. Oral Oncol 51(3):212–220. doi: 10.1016/j.oraloncology.2014.11.017 PubMedCrossRefGoogle Scholar
- 99.Romeo U, Galanakis A, Marias C, Vecchio AD, Tenore G, Palaia G, et al. (2011) Observation of pain control in patients with bisphosphonate-induced osteonecrosis using low level laser therapy: preliminary results. Photomed Laser Surg 29(7):447–452. doi: 10.1089/pho.2010.2835 PubMedCrossRefGoogle Scholar
- 102.Vescovi P, Giovannacci I, Merigo E, Meleti M, Manfredi M, Fornaini C, et al. (2015) Tooth extractions in high-risk patients under bisphosphonate therapy and previously affected with osteonecrosis of the jaws: surgical protocol supported by low-level laser therapy. J Craniofacial Surg 26(3):696–699. doi: 10.1097/scs.0000000000001665 CrossRefGoogle Scholar
- 112.Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A (2011) The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 19(5):685–690. doi: 10.1007/s00520-010-0888-8 CrossRefGoogle Scholar
- 115.Smoot B, Chiavola-Larson L, Lee J, Manibusan H, Allen DD (2015) Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis. J Cancer Survivorship: Res Practice 9(2):287–304. doi: 10.1007/s11764-014-0411-1 CrossRefGoogle Scholar
- 116.Wigg J, Lee N (2014) Redefining essential care in lymphoedema. British J Community Nurs S20(s2):s4–s7Google Scholar
- 119.van der Molen L, van Rossum MA, Jacobi I, van Son RJ, Smeele LE, Rasch CR, et al. (2012) Pre- and posttreatment voice and speech outcomes in patients with advanced head and neck cancer treated with chemoradiotherapy: expert listeners’ and patient’s perception. J Voice 26(5):664–633. doi: 10.1016/j.jvoice.2011.08.016 PubMedGoogle Scholar
- 122.Jacobi I, Navran A, van der Molen L, Heemsbergen WD, Hilgers FJ, van den Brekel MW (2015) Radiation dose to the tongue and velopharynx predicts acoustic-articulatory changes after chemo-IMRT treatment for advanced head and neck cancer. Eur Arch oto-rhino-Laryngol: Off J Eur Fed Oto-Rhino-Laryngol Soc (EUFOS): Affiliated Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. doi: 10.1007/s00405-015-3526-8 Google Scholar